The case study which is presented in the assignment is of a seventy four year old lady named Mrs. Evans which is a pseudonym chosen for this assignment according to guidelines of Nursing and Midwifery Council, 2018 to maintain the confidentiality and privacy of the patient. The location and the details of the patient were modified to maintain the anonymity. For those seeking guidance on similar topics, healthcare dissertation help can offer valuable insights and support. .
Mrs. Evans resides with her spouse and they have two children who stay away from them but visit them often. She worked until her age of 55 years as typist after that she left her job and it should be noted that her memory and recognition capability was definitely good. She was a cheerful lady and used to rehearse her belief in a Roman Catholic Church. She used to love travelling with his spouse and visited the community centre operational during the day time for two times a week and had home carers who used to support her twice per week. The leader of the church used to visit Mrs. Evans to uplift her status of psychological well being.
Her medical records revealed that she was suffering from Alzheimer’s disease as mentioned by the nurses of Community health centre. Her husband was his main support and carer. The condition of Alzheimer's disorder is a deteriorating issue that causes the cells of brain to deteriorate and ultimately death. Alzheimer's disorder is the one of the significant cause for dementia — a consistent reduction in conduct, perception, and social skills that perturbs a person potentiality to perform without restraint (Kumar, & Singh, 2015). The diseased condition is characterized by anomalous stores of proteins structure known as amyloid plaques which remains deposited all through the cerebrum. It is when the healthy nerve cells give up working or lose associations with different neurons eventually results in death. Memory issues are commonly one of the principal indications of cognitive inhibition identified with Alzheimer's disease. As the disease devastates nerve associations in the cerebrum, it makes increasingly logically hard to do standard things like move around, swallow and feeding oneself in the day to day life. Complications arising due to the progressive declining in the functioning of brain leads to the death of the patient (Kumar, & Singh, 2015). It was also stated in the medical records of Mrs Evans that she would not be able to get back to the tune of her previous life and her condition will worsen with time. .
The cerebrum is one of the biggest and most complex organs in our body; it is made out of billions of neurons that impart together by shaping various associations and neurotransmitters. There are three principle divisions: cerebrum, cerebellum and brain stem. The cerebral cortex originates from the most front part known as the forebrain area, of the neural tube. Prospective memory is considered to be a category of memory that involves reminding the schedules that any person has made in their life, which may include the straightforward every day plan to future long lasting plans, communication and language. Therefore, any kind of harm to prefrontal cortex eventually results in development of sincerely heartless conduct, performance of socially unseemly practices, and the person will not be able to make a normal judgment. The capacity to choose or decide something includes the process of thinking, learning, and creativity (Kuo, Sjöström, Chen, Wang, & Huang, 2009).
The motor system of brain is located in the frontal projections. It begins with premotor regions, for arranging and organizing complex developments and closures occurs at the primary cortex, from where the information is sent down the spinal rope to cause contraction and relaxation of the concerned muscles for performing the activity. The primary motor cortex situated on the left half of the brain controls development of the right side of the body, and the other way around. Different regions of the primary cortex associate with and control, development of various pieces of the body, framing a sort of body map known as the homunculus (Bläsing, Calvo-Merino, Cross, Jola, Honisch, & Stevens, 2012).
Individuals who are in the beginning period Alzheimer's disease frequently experience difficulty in recalling things. As the condition of the disease deteriorates, the plaques along with the tau tangles additionally show up in the pieces of the cerebrum responsible for normal functioning of the body system. Regular exercises like strolling, eating, setting off to the restroom, and talking becomes more difficult with the progression of the disease. In case of Mrs Evans, with the progression of the disease, the logical reasoning, thoughts, recollection, memories had worsened considerably. She was observed to demonstrate problems concerning communication and her feelings, and also showed aversion towards any activities. The most significant impact of the disease was that she was unable to carry on her essential daily activities such as brushing her teeth, eating and drinking, washing and clothing, combing her hair and so on. These caused immense anxiety development within her husband as he was unable to manage her conditions (Abrahams, 2016).
The Roper-Logan-Tierney Model for Nursing is a hypothesis of nursing care depending on the varied exercises of day to day living, which are frequently denoted as ADLs or ALs. The model is widely used in the United Kingdom, particularly in the public sector. There are 12 exercises of living as mentioned in the model for example correspondence, keeping a safe environment, eating and drinking (ED), motility, personal hygiene, maintenance of body temperature, sleeping, excretion, sexual behaviour and ultimately death (Roper, 1979).
There are various factors such as psychological, biological, environmental, sociocultural, and politicoeconomic. The joining of these elements into the hypothesis of nursing makes it an all encompassing model. The biological factor addresses the general wellbeing, of current injury and ailment, and the extent of freedom of the patient along with the physiology. The psychological factor deals with the feelings, comprehension, philosophical beliefs, and the capacity to comprehend. The sociocultural addresses the culture and society as felt by the concerned patient. This integrates longings and virtues reliant on category and status, and culture inside the sociocultural factor identifies with the convictions, desires, and qualities held by the individual patient for oneself, just as by others relating to autonomy and the capacity to complete the exercises of daily living. The environmental factor in nursing hypothesis classified it as "green" model. The hypothesis mulls over the effect of the immediate environment on the exercises of everyday living, yet in addition it also analyzes the effect of the exercises of day to day living on the environment. The politicoeconomic factor is the effect of the administration, governmental issues, and economy on the exercises of everyday living (Roper, 1979). This model is the decent choice for Mrs Evans as she was suffering from Alzheimer’s disease and the diseased condition affected her reasoning, recollection and thought process in a rapid way. Moreover, it was reported in her clinical records that she would never be able to lead a complete healthy life as before and with the progress of time her condition will worsen. She was also unable to carry on her daily activities like brushing her teeth, combing her hair, dressing up and washing. She needed assistance in all her daily tasks and was showing complete reliance. She was also facing difficulty in expressing her feelings and was showing aversion towards eating and drinking and towards any other activities. Therefore, the three relevant chosen activities of living for Mrs Evans Eating and Drinking, Communication and Personal Hygiene which was found to be altered in case of Mrs Evans due to her diseased health condition.
This AL incorporates not just the physical demonstrations of eating or drinking yet likewise the action of getting and planning nourishment. Issues may accordingly incorporate physical ones identified with swallowing, chewing, taking care of self and the capacity to arrive at the shops or to cook. The activity also points towards the mental or emotional challenges in relation to information or inspiration. The eating and drinking might be a consoling action, just as a fundamental living movement, in the midst of despondency or stress. The activity also addresses the financial issues of accessibility of assets. It will be promptly observed that issues related to mobility is may influence this activity which interprets that cases of the exercises are primarily interrelated (Newton, 1991).
As discussed previously, Mrs Evans was showing aversion towards carrying out the activities of eating and drinking. She was getting weaker with passing days as she was not having a balanced diet required by her body to function effectively. It is also evident that a significant number of aged patients suffering from Alzheimer's disease are underweight because of the impaired cognitive abilities due to which they are unable to follow the instructions during feeding and also faces problem while swallowing of food resulting in difficulty during ingestion (World Health Organization, 2014). Therefore, according to the guidelines of NICE, 2006 on the nutrition of older patients where it stressed on the necessity to assist these people while feeding. Moreover, the advanced patients of Alzheimer's disease need to be provided with comfort feeding and proper hydration as the main motive of nutrition. Mrs Evans was not in taking proper liquid this may be due to her aversion, difficulty in communication or due to her forgetfulness to swallow the liquid. This may affect her health by showing signs of severe head pains, problems in her urinary tract function and bowel function. To help her in her diseased condition, Mrs Evans was encouraged to have her meals according and assisting her during that time. She was also enquired about her swallowing difficulties and the need to crush down the food into smaller pieces for her comfort during eating. When she was unable to follow the instructions, the spoon with food was taken up to her mouth and touched her chin to remind her about the chewing of food. A dietician was also included within the team of doctors to get proper advice regarding her diet and weight.
Communication:
Correspondence is a basic piece of interaction in a social environment: it incorporates correspondence of all types such as talking, reading, writing and also all types of non-verbal correspondence. Issues with conveying may have physical reasons, for example, impedances of discourse, sight or hearing; there might be mental or physical problematic reasons and there might be social or language hindrances also. Emotional sentiments, mentalities, any sorts of mental issues such as anxiety or depression and torment are totally conveyed, verbally or non-verbally, deliberately or subliminally. Therefore, torment as an issue, except if clearly identified with some other AL, is incorporated under this consideration (Newton, 1991). Communicating with aged patients of Alzheimer's disease is a challenging task as these patient suffers from cognitive impairment and it becomes difficult for them to express their feelings and emotions (NICE, 2006). It was evident that older patients with Alzheimer's disease show adverse behaviour out of anxiety and fear response and it exacerbates with the negative behaviour of nurses (Jensen et al., 2010). In case of Mrs Evans, she was not communicating at all. She showed disinterest towards any kinds of activities and was also demonstrating speech problems. Moreover, she was also unable to communicate about her feelings of uneasiness, pain or any discomfort within her body. Therefore, based on the above mentioned reasons, a more patient and comprehending approach involving both verbal and non verbal modes of communication was taken for Mrs Evans. Constant monitoring of the patient was done to record any further signs of deterioration or pain. In this regard, the Alzheimer's general public (2019), guides the experts to take caution about their area, tone, selection of words, speed and non-verbal communication when attempting to speak with Alzheimer's patients. Simple adjustments have to be made with these patients such as use of short sentences, warm vocabulary and tone along with a smiling face which are central to quality care service by nurses.
Personal Hygiene:
This AL incorporates the physical demonstrations of doing exercises to maintain the status of hygiene; it likewise incorporates the state of the skin, so pressure-territory care is remembered for this AL. Grooming and cleansing of the body are basic components to maintain sound health. Activities incorporate skin purifying, care of the nails, hair, feet, mouth and teeth. Garments are worn for individual beautification and security. Individuals have a social duty to keep up tidiness of body and garments to forestall the spread of disease (Newton, 1991). Mrs Evans was unable to carry on her personal hygiene activities such brushing of her teeth, combing her hair and washing and dressing. Therefore, she was assisted to carry on such activities during her day to day life in a very compassionate way.
The Health and Social Care Delivery Plan, 2016 was formulated on 19th December 2016.The arrangement sets out the aspiration of helping the wellbeing and social consideration framework to augment in order to meet more readily the present and future demands. The meeting of the NHS Senior Leaders Forum on January eleventh focussed on execution of the Delivery Plan, especially on the necessity for an alternate way to deal with local arranging and conveyance, and also on the close joint effort with respect to the National Boards. As a major aspect of the declaration of designations contained inside the Draft Scottish Budget, the 8 Special Health Boards have been approached to work together and to share administrations to convey reserve funds of £15 million. The paper additionally gives a short update on work proceeding to guarantee that they can create a Local Delivery Plan, a Financial Plan and an Operational Plan containing all our point by point conveyance focuses, in accordance within the required timescales.
Instructive Implications
There is an open door for NES to play a more noteworthy influential position corresponding to Education and Training at both undergraduate and post-graduate levels. The recommendations in this paper would likewise bring about their job reaching out to past instruction, preparing and workforce improvement, into supporting workforce frameworks, the arrangement of information, and representative commitment and to provide backing across NHS Scotland.
Monetary Implications
It will be fundamental for them to begin to reshape the utilization of the assets to help new needs which it is already concurred should be taken forward. The link to the Health and Social Care Delivery Plan, 2016 is given below for reference: The plan also stated that the creation of Local Delivery Plan will be their conventional strategy for drawing in with Scottish Government comparable to this new explanation of the needs to help the Health and Social Care Delivery Plan. They will likewise keep on drawing in with the other National Health Boards and with the locales as their structures begin to come to fruition. Moreover, they should have a reasonable correspondence approach for staff and partners in connection to zones of new exercises, and exercises which may require be calling down or suspending (Health and Social Care Delivery Plan, 2016).
It will be fundamental for them to begin to reshape the utilization of the assets to help new needs which it is already concurred should be taken forward. The link to the Health and Social Care Delivery Plan, 2016 is given below for reference: The plan also stated that the creation of Local Delivery Plan will be their conventional strategy for drawing in with Scottish Government comparable to this new explanation of the needs to help the Health and Social Care Delivery Plan. They will likewise keep on drawing in with the other National Health Boards and with the locales as their structures begin to come to fruition. Moreover, they should have a reasonable correspondence approach for staff and partners in connection to zones of new exercises, and exercises which may require be calling down or suspending (Health and Social Care Delivery Plan, 2016).
AHPs across Scotland had organized anticipation and premature intercession to guarantee right of entry to mediations as soon as possible for most needed advantage, this incorporates the following:
The patient, Mrs Evans can be incorporated under the care vision of Alzheimer's Association and Alzheimer's Research in the United Kingdom. In the United Kingdom, in excess of 1,000,000 human beings are existing with the condition of dementia. Throughout the globe, approx 44 million persons are suffering from dementia, making the clinical condition a universal health urgent situation that must be straight away analysed. An analysis of Alzheimer's disease is something unbelievable for the individual with the malady, just as their loved ones, yet findings and support both are accessible on the electronic databases (Alzheimer's Association). As the world's developed voluntary wellbeing association, committed to Alzheimer's consideration, backing and research, the Alzheimer's Association endeavours to improve personal satisfaction for those confronting Alzheimer's sickness and different dementias. They subsidize basic research; give training and assets; bring issues to light; and provides backing in association with government, private and philanthropic associations for an answer for the worldwide Alzheimer's plague. The crucial the Alzheimer's Association is to dispense with Alzheimer's disease through the progression of research; to give and improve care to each one of those influenced; and to decrease the danger of dementia through the advancement of wellbeing of the brain (Alzheimer's Association). Alzheimer's Research UK works on dementia yet additionally responds to inquiries concerning dementia and research areas on Alzheimer's disease, including how the patient and their loved ones can get included. The foundation's information helpline – on 0300 111 5 111 – can give assistance and direction to the patient (Alzheimer's Research UK). Therefore, the above two mentioned health promotion services can provide valuable support to Mrs Evans. The site www.Alz.org gives a top to bottom clarification of how Alzheimer's and different dementias influence the cerebrum, side effects and hazard factors, exceptional reviews of medications, and assets to support the two guardians and individuals with dementia, here in case Mrs Evans and her husband. The data is accessible in 15 languages. This site gives tips from other people who are also living with Alzheimer's, disease data on
the best way to live well with the condition of the disease and assets for anticipating the future. The care required by somebody with Alzheimer's diseases and other dynamic dementias changes after some time. Therefore, this particular caregiver centres gives understanding on what's in store and how to adjust care during the early, middle and during the late phases of Alzheimer's illness. Assets remember articles for how to manage social changes and day to day care, free online courses and sites from other people who are thinking about somebody with dementia. A wide expansiveness of data is accessible, including what analysts are presently thinking about wellbeing of brain, recordings about Alzheimer's and hereditary disease chances, the eventual fate of symptomatic tests, and a review of potential Alzheimer's medicines and other treatment facilities which are under scrutiny (Alzheimer's Association). The association also raises assets to proceed with their interest in Alzheimer's exploration, care and backing. Their universal pledge drive, Alzheimer's Association The Longest Day,® unites groups from around the world to respect those confronting Alzheimer's disease while funds are also raised for the cause. The association advocates for the rights and needs of individuals who are suffering from Alzheimer's disease. The association does this in the United States by illuminating chosen authorities regarding both the financial and psychological expense of Alzheimer's disease condition, and by voicing the requirement for subsidizing from the U.S. government to propel Alzheimer's examination (Alzheimer's Association).
Take a deeper dive into Chronic obstructive pulmonary disease with our additional resources.
Kumar, A., & Singh, A. (2015). A review on Alzheimer's disease pathophysiology and its management: an update. Pharmacological reports, 67(2), 195-203.
Kuo, W. J., Sjöström, T., Chen, Y. P., Wang, Y. H., & Huang, C. Y. (2009). Intuition and deliberation: two systems for strategizing in the brain. Science, 324(5926), 519-522.
Bläsing, B., Calvo-Merino, B., Cross, E. S., Jola, C., Honisch, J., & Stevens, C. J. (2012). Neurocognitive control in dance perception and performance. Acta psychologica, 139(2), 300-308.
Roper, N. (1979). Nursing based on a model for living. Colledge and Jones. Newton, C. (1991). The components of the model and the nursing process. In The Roper-Logan-Tierney Model in Action (pp. 20-32). Palgrave, London. World Health Organization (2014) Nutrition for older persons [Online]. Available from: http://www.who.int/nutrition/topics/ageing/en/index1.html (Accessed: 1 February, 2020).
National Institute for Health and Clinical Excellence (NICE) (2006) Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. London: NICE. Jensen, G., Mirtallo, J., Compher, C., Dhaliwal, R., Forbes, A., Grijalba, R., Hardy, G., Kondrup, J., Labadarios, D., Nyulasi, I., Castillo Pineda, J. & Waitzberg, D. (2010) ‘Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee’, Journal of Parenteral and Enteral Nutrition, 34(2), pp. 156-159. Alzheimer’s society. (2019). Communicating and language. [Online]. Available at: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/communicating-and-language [Accessed 10/04/2020]. Health and Social Care Delivery Plan (2016) Health and social care delivery plan: progress report (2016): Available Online https://www.gov.scot/publications/health-social-care-delivery-plan/ [Accessed 10/04/2020].
Alzheimer's Association, Alzheimer's and Dementia Resources. Available Online https://www.alz.org/uk/what-we-do.asp [Accessed 10/04/2020]. Alzheimer's Research UK Available Online www.alzheimersresearchuk.org [Accessed 10/04/2020].
https://www.lenus.ie/bitstream/handle/10147/333669/modelofnursing.pdf?sequence=1&isAllowed=y https://link.springer.com/chapter/10.1007/978-1-349-11418-4_3 https://www.brightfocus.org/alzheimers-disease/infographic/progression-alzheimers-disease
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